'Unrealistic, madness, divisive': Three unionist parties rubbish BMA chief's all-Ireland GP services suggestion

The idea was suggested by the chairman of the British Medical Association’s (BMA) Northern Ireland council, Dr Alan Stout.

Now the DUP MLA Diane Dodds has called the idea “neither necessary nor realistic”, whilst the TUV has dubbed it “madness” and the UUP called it “divisive”.

The UUP health minister Mike Nesbitt has stressed that he does not have “any plans to consider an all-island system”, adding that he remains committed to free, publicly-financed GP care.

Dr Stout has defended his position, saying: “This is all about health service and health outcomes, not constitutional change.”

The issue emerged when Dr Stout posted on Twitter (@AlanStout19, 5,200 followers): "Let’s start the debate. We need an all Ireland GP service based on their medical card contract. They’ve solved and improved service and outcomes while we get much worse…"

He went on to say "let’s just go all Ireland with [our] healthcare and then let the politics catch up" adding: "We’re in a death spiral here."

One Twitter user (@ianjamesparsley, 7,900 followers) replied to him, saying: "Going all-Ireland with our healthcare is political. Whatever the merits or demerits of it, we have a plan from 2016 - agreed at the time by unionists, nationalists and others - to reform and improve our health service. It still has not been implemented. Let’s start there."

This is a reference to the Bengoa report, a giant review of the healthcare system published that year.

Dr Stout replied: "Nine years and we’ve gone backwards. I know the plan inside out (with obvious DoI) and we would be in a vastly different position if we’d even partly followed it."

That Twitter exchange followed on from an earlier tweet of his praising a recent presentation by a member of the Irish Medical Association, in which he said: "It is simply incredible the different level of service, different commitment to GP care and vastly different outcomes patients a matter of a few miles apart receive."

One Twitter user (@arleneseesit, 2,600 followers) had posed the question to him: "Are the better outcomes in RoI linked to the 50% of patients who are covered by private medical insurance? Should we compare like with like, private sector NI with private sector ROI?"

Dr Stout had replied: "My biggest learning point was that it’s actually the medical card patients and arrangements that are so much better. They resource, stratify, incentivise, prevent so much better than we do."

The Republic’s GP system is quite different to Northern Ireland’s largely public system.

Roughly half of patients in the Republic use private GP care, paying per appointment, with the other half being eligible for free care via either a Medical Card or a GP Visit Card.

WHAT HAS THE RESPONSE BEEN?

In response to Dr Stout, minister Nesbitt told the News Letter: “I and my department remain fully committed to the principle that health should be free at the point of service. This includes the service provided by GPs.

"We have no plans to introduce a hybrid system, which would mean some patients having to pay to see their GP, nor do we have any plans to consider an all-island system.

“My priority always has been, and remains, protecting patients and stabilising general practice.”

Diane Dodds MLA, the DUP’s health spokeswoman, said: “Co-operation with neighbouring jurisdictions, whether across the UK or the Irish Republic, already takes place and will continue where it brings clear benefits for patients.”

But she went on to say that “proposals for an all-Ireland healthcare system are neither necessary nor realistic,” adding: “The fundamental principle of the NHS is healthcare free at the point of delivery. Has Dr Stout renounced this belief on behalf of the BMA?

"The issues facing GPs can be, and must be, addressed here in Northern Ireland.

"What practices need right now is workforce stability, investment in multidisciplinary teams, and reform of the systems that are slowing them down.

"These are decisions that lie with our own health minister and executive, and we should focus on getting them right.

“Our priority is building a sustainable, high-quality health service for the people of Northern Ireland.

"That means practical cooperation across borders where helpful, but firm commitment to solutions that work for our patients and are accountable to the people we serve.”

The TUV said in a statement: “The suggestion by the BMA that there should be an all-Ireland GP service is madness.

"People in Northern Ireland have no desire to swap their NHS free at the point of access for the model in the Irish Republic where people are charged.

"This is a proposal born out of political pressure from elements inside the organisation rather than a desire to deliver the best for the people of Northern Ireland.

"It is frankly outrageous that the BMA have permitted themselves to be used in this fashion."

And the UUP issued a party statement of its own to the News Letter, saying: “The NHS was built on the principle of universal access, free at the point of delivery.

"To flirt with models that involve means-testing or payment for access is to flirt with inequality.

"As Aneurin Bevan, the architect of the NHS, rightly said: 'No society can legitimately call itself civilised if a sick person is denied medical aid because of a lack of means.'

“Health inequalities in Northern Ireland are not simply the result of GP contracts, they are deeply rooted in socio-economic disadvantage, educational disparity, housing conditions, and regional investment gaps.

"To suggest that a change in administrative structure alone would solve these complex issues is reductive and misleading.

“Moreover, the Republic of Ireland’s system, while different, is not without its own challenges. Many patients still face out-of-pocket costs, and access is not universally free. The idea that importing this model would automatically improve outcomes in Northern Ireland is not supported by evidence.

“The Ulster Unionist Party stands firmly behind our Health Minister, Mike Nesbitt, who has already delivered a long-overdue pay award for health workers, including an additional £12 million for GPs and their staff. This is real progress support for those on the front lines.

“What patients need now is stability, not political stunts, or divisive rhetoric.

"The Ulster Unionist Party will never support the privatisation of primary care.

"We remain committed to defending the NHS and ensuring that every citizen, regardless of income or postcode, has access to high-quality healthcare.”

‘NOT ABOUT CONSTITUTIONAL CHANGE’:

Dr Stout told the News Letter: “This is all about health service and health outcomes, not constitutional change.

"Our NHS is really struggling and we need big change such as suggested in Bengoa and the reports preceding it.

"The lack of that change has resulted in the difficulties we see and we face and we need to look to other systems, including the Irish system, to see and learn what they are doing better and how they are achieving better outcomes.”